产钳助产术后女性盆底机能的三维超声评估

目的应用盆底三维超声评估产钳助产术后女性的盆底机能。 方法选取2019年4月至2019年12月在湖北省妇幼保健院行产后42~60 d常规检查的女性150例（分娩组），其中产钳助产分娩组75例，自然阴道分娩组75例；同期于湖北省妇幼保健院选取无分娩史的女性100例为对照组。纳入对象均进行经会阴盆底三维超声检查。静息状态下测量膀胱颈的位置、膀胱后角、尿道倾斜角、肛提肌裂孔面积；最大Valsalva动作时测量膀胱颈移动度、尿道旋转角、膀胱最低点（膀胱颈或膀胱后壁）位置、尿道内口有无漏斗化、膀胱后角、肛提肌裂孔面积。采用独立样本t检验、方差分析、χ²检验对比分析静息状态及最大Valsalva动作时组间各测量指标的差异。 结果静息状态下，膀胱颈到参考线的距离，对照组、自然阴道分娩组、产钳助产分娩组依次减小，肛提肌裂孔面积，对照组、自然阴道分娩组、产钳助产分娩组依次增大，两两比较差异均有统计学意义（P均＜0.05）。最大Valsalva动作时，膀胱颈移动度、尿道旋转角及肛提肌裂孔面积，产钳助产分娩组、自然阴道分娩组、对照组均依次减小，两两比较差异均有统计学意义（P均＜0.05）。 结论产钳助产可能导致女性盆底机能受损，盆底三维超声可评估盆底结构及功能的改变，从而为临床提供诊断和治疗依据。

Three-dimensional ultrasonic evaluation of female pelvic floor function after forceps assisted delivery

ObjectiveTo analyze the sonographic changes of maternal pelvic function after forceps assisted delivery by pelvic floor ultrasound. MethodsOne hundred and fifty puerperae who underwent routine examinations at 42-60 days postpartum were selected at Material and Child Health Hospital of Hubei Province from April 2019 to December 2019, including 75 undergoing forceps assissted delivery and 75 undergoing natural vaginal delivery. One hundred undelivered women were selected at Material and Child Health Hospital of Hubei Province from April 2019 to December 2019 as a control group. All the subjects underwent three-dimensional ultrasound examination via perineal pelvic floor. The position of the bladder neck, posterior bladder angle, inclination angle of the urethra, and the area of the levator hiatus were measured at rest. During maximum Valsalva movement, the movement of the bladder neck, rotation angle of the urethra, position of the lowest point of the bladder (neck or posterior wall of the bladder), infundification of internal urethral orifice, posterior angle of the bladder, and area of the levator hiatus were measured. Independent sample t test, analysis of variance, and χ² test were used to compare the differences of each measurement index at the resting state and maximum Valsalva action between groups. ResultsIn the resting state, the distance from the bladder neck to the reference line decreased successively in the control group, the natural vaginal delivery group, and the forceps assisted delivery group, while the area of the levator hiatus increased successively in the control group, the natural vaginal delivery group, and the forceps assisted delivery group, with statistically significant differences in pairwise comparisons (P＜0.05 for all). At maximum Valsalva movement, bladder neck movement, urethral rotation angle, and anal levator hiatus area decreased successively in the forceps assisted delivery group, the natural vaginal delivery group, and the control group, and pairwise comparisons showed statistically significant differences (P＜0.05 for all). ConclusionForceps assisted delivery may lead to pelvic floor function impairment in women. Pelvic floor three-dimensional ultrasound can evaluate the changes of pelvic floor structure and function in these women to provide a basis for clinical diagnosis and treatment.